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Trying to Get A Hernia Diagnosis
As we have reported before, a negative ultrasound is not helpful if the clinical suspicion is high for a hernia. That is, there is a high false negative rate with ultrasounds. If there is a clinical suspicion, then further imaging (CT with Valsalva without contrast) may be warranted. That said, for umbilical hernia, a physical exam is all that is usually needed. And if she has discomfort and it affects her daily activities, that warrants intervention.
Before any procedure, I would address the straining with bowel movement. Why is she straining? That is not normal and poses a high risk for hernia development and recurrence after any repair. All straining must be cured prior to any hernia repair. If it is a constipation issue, I recommend to my patients any combination of milk of magnesia, mineral oil, and/or Miralax.